Miscarriage

I was a bit shocked when I recentlyread an article on public perceptions of miscarriage. It was from the USA but I am sure that the findings would be similar if the same study was carried out in

Australia. It found that misconceptions regarding miscarriage are common. More than half of the people asked in the survey thought that miscarriage was rare. More than a third thought that they could have prevented the miscarriage. Many attributed the miscarriage to stress, lifting heavy objects, past history of sexually transmitted infections, past use of contraception or even arguing. Almost half of those asked felt guilty about the miscarriage, 41% felt they had done something wrong, 26% felt like they had lost a child, 28% felt shame. The misconceptions that I had seen in couples for myself were all there in black and white in this article. The emotional fallout following a miscarriage that I have seen many times was also there.

If you look up miscarriage in the dictionary one of the definitions that you will find is “an unsuccessful outcome of something planned”. This definition is a little sterile. It’s lacking in emotion. It doesn’t quite get across the turmoil that occurs when a miscarriage slaps you in the face, kicks you in the guts and undoes all those plans that you had in your head. But.. it does, quite simply, almost eloquently, lays out the bare bones of what has happened. It doesn’t use the medical terms that I might use – like early pregnancy failure or blighted ovum. It doesn’t even touch on the different types of miscarriages that might occur – complete, incomplete, inevitable, missed. It does however tell a story – short and not so sweet – of a hope for the future which is now in the past.

Very early on in my O&G career I realised that I had to develop a way of approaching couples with miscarriages that got the message across as to what had happened, and how to move forward. I had to somehow in their sorrow get across to them some simple but important facts that would educate and comfort them. Some of you who have seen me with a miscarriage will remember some of what will follow in this blog. I’ve not really changed it much over the last 15 years or so.

Miscarriage is not rare. Miscarriage occurs in 10-25% of all clinically recognised pregnancies. That is, in those pregnancies where the woman has a confirmed pregnancy. Some estimates would say that up to 40-50% of all conceived pregnancies miscarry. In some of those pregnancies the woman never realises that she was pregnant. For example, in some circumstances where a woman thinks that she has had a late heavy period – she may have actually miscarried.

The most important thing that a woman and her partner need to know is that they didn’t cause the miscarriage and they could not have prevented it from occurring. I have heard the strangest things from couples as they struggle to come to grips with the fact that they have miscarried. I have had women tell me, “I ate a tuna sandwich last week. Could that have caused it?” I’ve had partners say, “We had sex a fortnight ago. Could that have caused it?” All those funny little question running around in your head – try and ignore them. You did not cause this miscarriage.

So, why do miscarriage happen? In the overwhelming majority of cases it is due to a genetic error in the developing pregnancy. The pregnancy gets to a certain point where it then doesn’t develop any further and miscarriage occurs. With the number of steps to form one egg, the number of steps to form one sperm and the number of steps for them to get together to form a normal embryo – it’s a miracle that any of us are here. Miscarriages are so common that investigations for causes of recurrent miscarriage are not done until at least 2 or 3 miscarriages have occurred. When the testing is done, the majority of the tests often come back empty handed.

Everyone’s’ reaction to miscarriage is different. Some couples are very matter of fact – they’re quite accepting of the fact that “these things happen” and they relatively quickly pick up the pieces and try to fall pregnant again within a fairly short time. Some couples, fall apart at the seams and can take months before they recover emotionally. Often the woman takes longer. Even when she knows that she didn’t cause the miscarriage, she often blames herself. Most couples lie somewhere in between these two extremes. It’s a terrible time, they’re very sad for a period of time but slowly recover from their loss. Everyone recovers at their own rate. Often one half of a couple will recover quicker than the other and if they’re not aware of the differing rates of recovery can find themselves thinking “Jeepers, it’s been (x number of) months since the miscarriage. Can’t we move on.” Some people take longer – much longer than others. It’s important to be patient.

Some women can be very traumatised by the miscarriage and need psychological input to help them get through the grief. There are lots of online and face-to-face support organisations in dealing with your loss. A couple of them include http://www.pregnancylossaustralia.org.au and http://www.sands.org.au

The other thing that couples want to know about is – Where do we go from here? There are essentially three options when it comes to dealing with miscarriages. The first option is to do nothing and “let nature take it’s course” (expectant management). About 70-80% of miscarriages will eventually occur naturally and successfully without any outside assistance but it can take weeks. The second option is to assist the process of expectant management by using medication which softens and opens the cervix and brings on contractions within the uterus to help expel the miscarriage. This is successful in about 70-80% of cases and the time course is usually quicker. The third, surgical, option is one which some women prefer to undergo immediately or to use after the first two options have failed. This option involves a curette where a tube is inserted via the cervix into the uterus and suction is used to empty the uterus. A general anaesthetic is required. Complications are uncommon but can occur with all three options. The option that a woman chooses is personal and decided on after a discussion of her individual circumstances and medical status.

After a miscarriage there is usually a delay of between 4 and 6 weeks before the next period. The standard recommendation in the past was for couples to wait for 2 to 3 months before trying again. However, research has indicated that there is probably no benefit to waiting. I generally recommend waiting until the woman has had a normal period prior to starting again. Obviously if there is a question of recurrent miscarriage then it is prudent to undergo investigation of this possibility prior to trying again.

The good news is that almost all women who have had a miscarriage will go on in future pregnancies to have a baby. You might require medication. You might require support in the form of IVF or other treatments. The majority will require no assistance at all.

Note: If you wish to have a read of the article then you can look at it HERE. Just click on the “Article as PDF” link to the right of the summary and a pdf will open up with the full article.

I’ll also upload it to my Facebook Documents group HERE.